Abstract:

Objective　To observe the influencing factors of catheter misplacement in neurosurgical ultrasound-guided modified medium-length catheter placement, and to construct a prediction model, in order to provide a reference for clinical reduction of catheter misplacement. Methods　A total of 110 patients, 72 males and 38 females, aged (58.38±9.06) years, who underwent ultrasound-guided modified medium-length catheter placement in Department of Neurosurgery, Shantou Central Hospital from October 2019 to December 2021 were selected. The patients were divided into a catheter misplacement group and a non-catheter misplacement group according to the statistics of catheter misplacement situation. The clinical data of the two groups were collected, and univariate analysis (χ² test, Fisher exact probability test, or two independent sample t test) was performed. Factors with statistically significant differences in the univariate analysis were included in logistic multivariate regression analysis to screen out the independent risk factors for catheter misplacement. On this basis, a risk prediction model was constructed. The receiver operating characteristic curve (ROC) was used to analyze the predictive power of each independent risk factor and the risk prediction model for the occurrence of catheter misplacement. Results　There were 10 cases of catheter misplacement in the 110 patients, accounting for 9.09%. Logistic regression analysis showed that catheterization vein, catheterization length, and tracheostomy were independent risk factors for catheter misplacement (OR = 2.436, 2.076, and 2.258; all P<0.05). The ROC analysis showed that catheterization vein, catheterization length, and tracheotomy all had certain predictive values for the occurrence of catheter misplacement, and the areas under the curve (AUC) were 0.741, 0.728, and 0.735, respectively. The AUC of the risk prediction model for predicting catheter misplacement was 0.858, and the prediction sensitivity of the risk prediction model was 70.00% and the specificity was 94.00% when the optimal cut-off point was selected. Conclusion　The risk factors of catheter misplacement in patients undergoing ultrasound-guided modified medium-length catheter placement in neurosurgery include catheterization vein, catheterization length, and tracheostomy, the risk prediction model constructed on this basis has a good predictive value for catheter misplacement, and targeted interventions can be taken to reduce the risk of catheter misplacement.

Key words: Neurosurgery, Ultrasound, Modified medium-length catheter, Catheter misplacement, Prediction model

摘要： 目的　观察神经外科行超声引导下改良型中等长度导管置入术导管异位的有关影响因素，构建预测模型，以期为临床减少导管异位情况提供参考。方法　选取2019年10月至2021年12月于汕头市中心医院神经外科行超声引导下改良型中等长度导管置入术患者110例，其中男72例，女38例，年龄（58.38±9.06）岁，统计患者导管异位情况，据此分为导管异位组、无导管异位组。收集两组患者临床资料，采取单因素分析（应用χ²检验、Fisher确切概率法、两独立样本t检验），对单因素分析差异有统计学意义的因素纳入logistic多因素回归分析，筛选出导管异位的独立危险因素，在此基础上构建风险预测模型，采用受试者工作特征曲线（ROC）分析各独立危险因素与风险预测模型对患者出现导管异位的预测效能。结果　本组110例患者共出现导管异位10例，占比为9.09%。logistic回归分析显示，置管静脉、置管长度、气管切开均为患者导管异位的独立危险因素［比值比（OR）分别为2.436、2.076、2.258，均P<0.05］。经ROC分析显示，置 管静脉、置管长度、气管切开均对患者出现导管异位具有一定预测价值，曲线下面积（AUC）分别为0.741、0.728、0.735，风险预测模型预测患者出现导管异位的AUC为0.858，取最佳界值点时风险预测模型的预测灵敏度为70.00%，特异度为94.00%。结论　神经外科行超声引导下改良型中等长度导管置入术患者出现导管异位的危险因素包括置管静脉、置管长度、气管切开，据此构建的风险预测模型对导管异位预测价值良好，可针对上述因素采取针对干预，以降低导管异位风险。

关键词: 神经外科, 超声, 改良型中等长度导管, 导管异位, 预测模型